For First Few Years, Better Survival with Peritoneal Dialysis than Hemodialysis

[PaulBC]

I missed this a few months back when I'm sure I skimmed this issue at least. I caught my eye, since there is an oft-stated claim that one modality is as good as another.

From January 2015 ASN Kidney News:

For First Few Years, Better Survival with Peritoneal Dialysis than Hemodialysis

Among patients with similar characteristics, those starting
peritoneal dialysis (PD) have higher survival through the first 2
or 3 years than do those starting hemodialysis
(HD), reports a study in Kidney International.

Using their managed care system’s ESRD registry, the researchers
identified 11,301 patients who were beginning PD or HD. From this
group, 1003 propensity-matched pairs of incident PD and HD
patients were identified. Eligible HD patients received
appropriate predialysis care, including permanent dialysis access
placement.  Survival was compared by intentionto-treat and
as-treated analyses.

The 1-year adjusted survival was 95 percent in the PD group
versus 89 percent in the HD group; the 2-year survival was 87
percent versus 83 percent, respectively. The 1-year cumulative
hazard ratio for death among incident HD patients, compared with
PD, was 2.38 on intention-to-treat analysis and 2.10 on
as-treated analysis.

The risk of death remained lower with PD through close to 3 years
on as-treated analysis and nearly 2 years on intention-totreat
analysis. There was no significant difference in mortality on
longer follow-up.

Studies comparing survival in incident HD and PD patients have
reported conflicting results. Reports of improved survival in
patients beginning PD might reflect the effects of early central
venous catheter use or other potential confounders.

This new propensity-matched analysis finds a significant survival
advantage with PD over the first 2 or 3 years. In the first year,
the cumulative risk of death is more than twice as high with
HD. The authors suggest that ongoing improvements in the
treatment of PD patients and avoidance of metabolic complications
might lead to a longer duration of survival benefit [Kumar VA, et
al. Survival of propensity matched incident peritoneal and
hemodialysis patients in a United States health care system.
Kidney Int 2014; 86:1016–1022].

[noahvale]

I missed this a few months back when I'm sure I skimmed this issue at least. I caught my eye, since there is an oft-stated claim that one modality is as good as another.

From January 2015 ASN Kidney News:

For First Few Years, Better Survival with Peritoneal Dialysis than Hemodialysis

Among patients with similar characteristics, those starting
peritoneal dialysis (PD) have higher survival through the first 2
or 3 years than do those starting hemodialysis
(HD), reports a study in Kidney International.

More meaningful comparison would be PD vs. HOME Hemodialysis:


New data shows home hemodialysis superior to PD for patient and technique survival, hospitalizations
By Mark E. Neumann

NOVEMBER 19, 2014

PHILADELPHIA – There has been an assumption that home dialysis therapies offer patients a better quality of life than conventional, in-center therapy. But which home dialysis modality offers the best outcomes?

Results of a new study conducted by the Chronic Disease Research Group (CDRG) presented here at the American Society of Nephrology's Kidney Week 2014 show daily home hemodialysis patients have a 16% lower risk of death, 8% lower risk of hospitalization, and 38% lower risk of therapy attrition than peritoneal dialysis patients.

http://www.nephrologynews.com/articles/110554-new-data-shows-home-hemodialysis-superior-for-patient-and-technique-survival-hospitalizations